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Chapter 17 : Ocular Tuberculosis

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Abstract:

This chapter describes several different mechanisms through which eye can become infected with tuberculosis. Tuberculosis can involve the lid, conjunctiva, cornea, and sclera. In parts of the world where the prevalence of tuberculosis infection is higher in the general population, uveitis is still more likely to be attributed to tuberculosis. Uveitis can also manifest as simple iritis, the clinical signs of which are limited to cells and flare in the anterior chamber, or as iridocyclitis with involvement of the ciliary body. Iridocyclitis occurs clinically with inflammatory cells in the ciliary body and anterior vitreous and is associated with ciliary body pain and ciliary vasodilation. Alternatively, the inflammation may involve primarily the posterior part of the uvea (choroids), leading to choroiditis, the most common manifestation of ocular tuberculosis. Choroidal tubercles should always be looked for on funduscopic examination when a patient is suspected to have tuberculosis or has a fever of unknown origin. The chapter also talks about choroidal tuberculomas, ciliary body tuberculoma, tuberculous retinitis, tuberculous panophthalmitis, and orbital tuberculosis. Before the introduction of PCR technology, a definitive diagnosis of ocular tuberculosis was often elusive because it required the demonstration of the bacilli in ocular tissues or secretions by microscopy or culture. Once the diagnosis of ocular tuberculosis is made, systemic antituberculous therapy should be initiated at once. Any patient with a clinical picture highly suspicious for ocular tuberculosis should be treated with a multidrug regimen of proven efficacy.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17

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Enzyme-Linked Immunosorbent Assay
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Ocular Infections
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Systemic Lupus Erythematosus
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Chronic Granulomatous Disease
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Figures

Image of Figure 1.
Figure 1.

(A) Case 1. Shown is a bulbar conjunctival mass contiguous with a peripheral corneal ulcer with 80% stromal thinning. (B) Everted upper eyelid shows diffuse papillary reaction with tarsal necrosis laterally. (C) Case 2. Downgaze shows ulcerated bulbar conjunctiva. (D) Everted upper eyelid shows diffuse velvety appearance, with cheesy white areas of necrosis involving the upper tarsal border. Reprinted with permission from the ( ). Copyright 2003 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 2.
Figure 2.

Case 1. A section from the bulbar conjunctiva shows an intact epithelium with discrete epithelioid cell granuloma in the deeper stroma, rimmed by lymphocytes (hematoxylin-eosin; original magnification, ×250). Reprinted with permission from the ( ). Copyright 2003 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 3.
Figure 3.

(A) Case 1. At 1-year follow-up, the left eye shows a superior vascularized corneal scar with normal-appearing bulbar and tarsal conjunctiva. (B) Case 2. At 3-month follow-up, the everted right upper eyelid shows a residual area of necrosis (arrow) with mild persistent papillary reaction. Reprinted with permission from the ( ). Copyright 2003 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 4.
Figure 4.

Slit lamp picture of the left cornea showing a peripheral corneal ulcer and a heavily vascularized nodule. Reprinted with permission from the ( ). Copyright 2000 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 5.
Figure 5.

Clinical appearance of a right eye shows mild conjunctival vasodilation and numerous confluent, temporal, tan iris nodules. Reprinted with permission from the ( ). Copyright 1998 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 6.
Figure 6.

(Left) Gross appearance of the enucleated right eye. Note the scleral necrosis and the perilimbal scleral rupture (arrowhead) located interiorly. The limbal conjunctiva covers a dome-shaped, brown mass. (Right) Histopathological appearance of the enucleated right eye with a subconjunctival necrotic and inflammatory mass. There is necrosis of the iris, and the anterior chamber contains necrotic debris (arrowheads) (hematoxylin-eosin; original magnification, ×5). Reprinted with permission from the ( ). Copyright 1998 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 7.
Figure 7.

Fundus photographs of the right (A) and left (B) eyes show bilateral, multifocal choroiditis (arrowheads). Serial fluorescein angiographic photographs (C to F) show early blocking hypofluorescence and late-staining hyperfluorescence corresponding to areas of choroidal infiltrate, as well as mild, late leakage from the optic nerve heads in each eye. Reprinted with permission from the ( ). Copyright 1998 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 8.
Figure 8.

B-scan ultrasonogram of the left eye showing an acoustically dense choroidal lesion with no choroidal excavation. Reprinted with permission from the ( ). Copyright 2000 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 9.
Figure 9.

Fluorescein angiogram in the early venous phase showing early blockage at the edges of the lesion and early hyperfluorescence within the central aspect of the choroidal lesion; the overlying retinal vessels are normal and in focus. The other retinal vessels are not in focus secondary to the thickness of the lesion. Reprinted with permission from the ( ). Copyright 2000 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 10.
Figure 10.

Fluorescein angiogram in the late phase revealing late staining of the choroidal lesion. Reprinted with permission from the ( ). Copyright 2000 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 11.
Figure 11.

Fundus photograph showing a white choroidal lesion causing the fovea to be ectopic. Reprinted with permission from the ( ). Copyright 2000 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 12.
Figure 12.

Fundus photograph of the left eye showing resolution of the choroidal tubercle with retinal pigment epithelium stippling within the resolving choroidal tubercle. Reprinted with permission from the ( ). Copyright 2000 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 13.
Figure 13.

Retinitis and retinal neovascularization obscuring a clear view of the optic disc in a fundus photograph. Reprinted with permission from the ( ). Copyright 1998 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 14.
Figure 14.

Noncaseating granuloma from a transvitreal biopsy specimen. Reprinted with permission from the ( ). Copyright 1998 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 15.
Figure 15.

Left fundus photograph illustrating optic disc new vessels with choroidal mass nasally. Reprinted with permission from the ( ). Copyright 1998 American Medical Association. All rights reserved.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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Image of Figure 16.
Figure 16.

Acid-fast stain of a conjunctival biopsy specimen shows acid-fast positive rods (arrow) within epithelioid histiocytes.

Citation: Albert D, Thompson, M, Peralta R. 2011. Ocular Tuberculosis, p 269-282. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch17
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References

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1. Abrams, A. B.,, and T. F. Schlaegel. 1982. The role of the isoniazid therapeutic test in tuberculosis uveitis. Am. J. Ophthalmol. 94:511515.
2. Abrams, A. B.,, and T. F. Schlaegel. 1983. The tuberculin test in the diagnosis of tuberculosis uveitis. Am. J. Ophthalmol. 96:295298.
3. Anders, N.,, and G. Wollensack. 1995. Ocular tuberculosis in systemic lupus erythematosus and immunosuppressive therapy. Klin. Monatsblaetter Augenheilkunde 204:368371.
4. Ang, M.,, H. M. Htoon,, and S. P. Chee. 2009. Diagnosis of tuberculosis uveitis: clinical application of an interferon-gamma release assay. Ophthalmology 116:13911396.
5. Arora, S. K.,, V. Gupta,, A. Gupta,, P. Bambery,, G. S. Kapoor,, and S. Sehgal. 1999. Diagnostic efficacy of polymerase chain reaction in granulomatous uveitis. Tuber. Lung Dis. 79:229233.
6. Babu, R. B.,, S. Sudharshan,, N. Kumarasamy,, L. Therese,, and J. Biswas. 2006. Ocular tuberculosis in acquired immunodeficiency syndrome. Am. J. Ophthalmol. 142:413418.
7. Balashevich, L. I. 1984. Argon laser-coagulation in focal chorioretinitis. Oftalmologia 7:414416.
8. Beare, N. A.,, J. G. Kublin,, D. K. Lewis,, M. J. Schijffelen,, R. P. Peters,, G. Joaki,, J. Kumwenda,, and E. E. Zijlstra. 2002. Ocular disease in patients with tuberculosis and HIV presenting with fever in Africa. Br. J. Ophthalmol. 86:10761079.
9. Biswas, J.,, S. Narain,, D. Das,, and S. K. Ganesh. 1996-1997. Pattern of uveitis in a referral uveitis clinic in India. Int. Ophthalmol. 20:223228.
10. Biswas, J.,, L. Therese,, and H. N. Madhavan. 1999. Use of polymerase chain reaction in detection of Mycobacterium tuberculosis complex DNA from vitreous sample of Eales’ disease. Br. J. Ophthalmol. 83:994.
11. Biswas, J.,, S. K. Kumar,, P. Rupauliha,, S. Misra,, I. Bharadwaj,, and L. Therese. 2002. Detection of Mycobacterium tuberculosis by nested polymerase chain reaction in a case of subconjunctival tuberculosis. Cornea 21:123125.
12. Blodi, B. A.,, N. W. Johnson,, and W. M. McLeish. 1989. Presumed choroidal tuberculosis in a human immunodeficiency virus infected host. Am. J. Ophthalmol. 103:605607.
13. Bloomfield, S. E.,, B. Mondino,, and G. F. Gray. 1976. Scleral tuberculosis. Arch. Ophthalmol. 94:954956.
14. Bouza, E.,, P. Merino,, P. Munoz,, C. Sanchez-Carillo,, J. Yanez,, and C. Cortes. 1997. Ocular tuberculosis: a prospective study in a general hospital. Medicine 76:5361.
15. Bowyer, J. D.,, P. D. Gormley,, R. Seth,, R. N. Downes,, and J. Lowe. 1999. Choroidal tuberculosis diagnosed by polymerase chain reaction. A clinicopathologic case report. Ophthalmology 106:290294.
16. Cangemi, F. E.,, A. H. Friedman,, and R. Josephberg. 1980. Tuberculoma of the choroid. Ophthalmology 84:252258.
17. Chandler, A. C.,, and D. Locatcher-Khorazo. 1964. Primary tuberculosis of the conjunctiva. Arch. Ophthalmol. 71:202205.
18. Chapman, C. B.,, and C. M. Whorton. 1946. Acute generalized miliary tuberculosis in adults. N. Engl. J. Med. 235:239248.
19. Chung, Y.,, T. Yeh,, S. Sheu,, and J. H. Liu. 1989. Macular sub-retinal neovascularization in choroidal tuberculosis. Ann. Ophthalmol. 21:225229.
20. Cohnheim, J. 1867. Ueber tuberkulose der choroiden. Virchows Arch. (Pathol. Anat.) 39:4969.
21. Cook, C. D.,, and M. Hainsworth. 1990. Tuberculosis of the conjunctiva occurring in association with a neighbouring lupus vulgaris lesion. Br. J. Ophthalmol. 74:315316.
22. Croxatto, J. O.,, C. Mestre,, S. Puente,, and G. Gonzalez. 1986. Nonreactive tuberculosis in a patient with acquired immune deficiency syndrome. Am. J. Ophthalmol. 102:659660.
23. Darrell, R. M. 1967. Acute tuberculosis panophthalmitis. Arch. Ophthalmol. 78:5154.
24. Demirci, H.,, C. L. Shields,, J. A. Shields,, and R. C. Eagle, Jr. 2004. Ocular tuberculosis masquerading as ocular tumors. Surv. Ophthalmol. 49:7889.
25. Dollfus, M. A. 1949. Fundus lesions in tuberculosis meningitis and miliary pulmonary tuberculosis treated with streptomycin. Am. J. Ophthalmol. 32:821824.
26. Domonkos, A. N.,, H. L. Arnold,, and R. B. Odom. 1982. Andrews’ Diseases of the Skin, Clinical Dermatology, 7th ed. W. B. Saunders, Philadelphia, PA.
27. Donahue, H. C. 1967. Ophthalmic experience in a tuberculosis sanatorium. Am. J. Ophthalmol. 64:742748.
28. D’Souza, P.,, R. Garg,, R. S. Dhaliwal,, R. Jain,, and M. Jain. 1994. Orbital-tuberculosis [sic]. Int. Ophthalmol. 18:149152.
29. El-Ghatit, A. M.,, S. M. El-Deriny,, A. A. Mahmoud,, and A. S. Ashi. 1999. Presumed periorbital lupus vulgaris with ocular extension. Ophthalmology 106:19901993.
30. Eliot, A. 1954. Recurrent intraocular hemorrhage in young adults. Trans. Am. Ophthalmic Soc. 52:811875.
31. Fernandes, M.,, G. K. Vemuganti,, G. Pasricha,, A. K. Bansal,, and V. S. Sangwan. 2003. Unilateral tuberculous conjunctivitis with tarsal necrosis. Arch. Ophthalmol. 121:14751478.
32. Fountain, J. A.,, and R. B. Werner. 1984. Tuberculous retinal vasculitis. Retina 4:4850.
33. Fraundelder, F. T. 1989. Drug-Induced Ocular Side Effects and Drug Interactions, 3rd ed. Lea & Febiger, Philadelphia, PA.
34. Frueh, B. E.,, O. Dubuis,, P. Imesch,, M. Böhnke,, and T. Bodmer. 2000. Mycobacterium szulgai keratitis. Arch. Ophthalmol. 118:11231124.
35. Gardiner, P. A.,, I. C. Michaelson,, E. J. W. Rees,, and J. M. Robson. 1948. Intravitreous streptomycin: its toxicity and diffusion. Br. J. Ophthalmol. 32:449456.
36. Gibson, W. S. 1918. The etiology of phlyctenular conjunctivitis. Am. J. Dis. Child. 15:81115.
37. Glover, L. P. 1930. Some eye observations in tuberculosis patients at the State Sanatorium, Cresson, Pennsylvania. Am. J. Ophthalmol. 13:411412.
38. Goldberg, M. F. 1982. Presumed tuberculous maculopathy. Retina 2:4750.
39. Goldenberg, M.,, and N. D. Fabricant. 1909. The eye in the tuberculous patient. Trans. Sect. Ophthalmol. Am. Med. Assoc. 135.
40. Grewal, A.,, R. Y. Kim,, and E. T. Cunningham, Jr. 1998. Miliary tuberculosis. Arch. Ophthalmol. 116:953954.
41. Gupta, V.,, A. Gupta,, S. Arora,, P. Bambery,, M. R. Dogra,, and A. Agarwal. 2003. Presumed tubercular serpiginouslike choroiditis: clinical presentations and management. Ophthalmology 110:17441749.
42. Gupta, V.,, A. Gupta,, and N. A. Rao. 2007. Intraocular tuberculosis—an update. Surv. Ophthalmol. 52:561587.
43. Gur, S.,, B. Z. Silverstone,, R. Zylberman,, and D. Berson. 1987. Chorioretinitis and extrapulmonary tuberculosis. Ann. Ophthalmol. 19:112115.
44. Illingsworth, R. S.,, and T. Wright. 1948. Tubercles of the choroid. Br. Med. J. 2:365368.
45. Islam, S. M.,, and K. F. Tabbara. 2002. Causes of uveitis at The Eye Center in Saudi Arabia: a retrospective review. Ophthalmic Epidemiol. 9:239249.
46. Jabbour, N. M.,, B. Farris,, and C. L. Trempe. 1985. A case of pulmonary tuberculosis presenting with a choroidal tuberculoma. Ophthalmology 92:834837.
47. Jennings, A.,, M. Bilous,, P. Asimakis,, and A. J. Maloof. 2006. Mycobacterium tuberculosis presenting as chronic red eye. Cornea 25:11181120.
48. Kesen, M.,, D. P. Edward,, N. A. Rao,, J. Sugar,, H. H. Tessler,, and D. A. Goldstein. 2009. Atypical infectious nodular scleritis. Arch. Ophthalmol. 127:10791080.
49. Khalil, M.,, S. Lindley,, and E. Matouk. 1985. Tuberculosis of the orbit. Ophthalmology 92:16241627.
50. Koch, R. 1882. Die Aetiologe der Tuberculose. Berliner Klin. Wochenschr. 15:221230.
51. Kratka, W. H. 1955. Isoniazid and ocular tuberculosis: an evaluation of experimental and clinical studies. Arch. Ophthalmol. 54:330344.
52. Leng, T.,, A. C. Schefler,, and T. G. Murray. 2009. Retinal vascular tumor and peripheral retinal vasculitis in the setting of systemic tuberculosis. Ophthalmic Surg. Lasers Imaging 40:409412.
53. Leopold, I. H.,, and A. Nichold. 1946. Intraocular penetration of streptomycin following systemic and local administration. Arch. Ophthalmol. 35:3338.
54. Lyon, C. E.,, B. S. Crimson,, and R. L. Peiffer. 1985. Clinicopathological correlation of a solitary choroidal tuberculoma. Ophthalmology 92:845850.
55. Madhavan, H. N.,, K. L. Therese,, P. Gunisha,, U. Jayanthi,, and J. Biswas. 2000. Polymerase chain reaction for detection of Mycobacterium tuberculosis in epiretinal membrane in Eales’ disease. Investig. Ophthalmol. Vis. Sci. 41:822825.
56. Maitre-Jan, A. 1707. Traite des maladies de l’oeil et des remedes propres pour leur guerison. Enrichy de plusieurs experiences de physique. Jacques le Febvre, Troyes, France.
57. Mansour, A. M.,, and R. Haymond. 1990. Choroidal tuberculomas without evidence of extraocular tuberculosis. Albrecht von Graefe’s Arch. Clin. Exp. Ophthalmol. 228:382385.
58. Mason, J. O. 2000. Treatment of large macular choroidal tubercle improves vision. Arch. Ophthalmol. 118:11361137.
59. Massaro, D.,, S. Katz,, and M. Sachs. 1964. Choroidal tubercles. Ann. Intern. Med. 60:231241.
60. Maurya, O. P. S.,, R. Patel,, V. Thakur,, and R. Singh. 1990. Tuberculoma of the orbit—a case report. Indian J. Ophthalmol. 38:191192.
61. Mehta, D. K. 1989. Bilateral tubercular lid abscess—a case report. Indian J. Ophthalmol. 37:98.
62. Mehta, S.,, V. Chauhan,, S. Hastak,, P. Jiadani,, and P. Dalal. 2006. Choroidal tubercles in neurotuberculosis: prevalence and significance. Ocul. Immunol. Inflamm. 14:341345.
63. Mori, T. 2009. Usefulness of interferon-gamma release assays for diagnosing TB infection and problems with these assays. J. Infect. Chemother. 15:143155.
64. Morimura, Y.,, A. A. Okada,, S. Kawahara,, Y. Miyamoto,, S. Kawai,, A. Hirakata,, and T. Hida. 2002. Tuberculin skin testing in uveitis patients and treatment of presumed intraocular tuberculosis in Japan. Ophthalmology 109:851857.
65. Morinelli, E. N.,, R. U. Dugel,, R. Riffenburg,, and H. M. Byron. 1993. Infectious multifocal choroiditis in patients with acquired immunodeficiency syndrome. Ophthalmology 100:10141021.
66. Muccioli, C.,, and R. Belfort. 1995. Presumed ocular and central nervous system tuberculosis in a patient with acquired immunodeficiency syndrome. Am. J. Ophthalmol. 121:217219.
67. Nanda, M.,, S. C. Pflugfelder,, and S. Holland. 1989. Mycobacterium tuberculosis scleritis. Am. J. Ophthalmol. 108:736737.
68. Ni, C.,, J. J. Papale,, and N. L. Robinson. 1982. Uveal tuberculosis. Int. Ophthalmol. Clin. 22:103124.
69. Olazabal, F. 1967. Choroidal tubercles. JAMA 200:374377.
70. Ortega-Larrocea, G.,, M. Bobadilla del Valle,, A. Ponce de Leon,, and J. Siguentes Osornio. 2003. Nested polymerase chain reaction for Mycobacterium tuberculosis DNA detection in aqueous and vitreous of patients with uveitis. Arch. Med. Res. 34:116119.
71. Outman, W. R.,, R. E. Levitz,, D. A. Hill,, and C. H. Nightingale. 1992. Intraocular penetration of rifampin in humans. Antimicrob. Agents Chemother. 36:15751576.
72. Paton, R. T. 1932. The clinical significance of choroidal tubercles. Ann. Intern. Med. 5:997999.
73. Peneau, A.,, D. Moinard,, I. Berard,, O. Pascal,, and J. P. Moisan. 1992. Detection of mycobacteria using the polymerase chain reaction. Eur. J. Clin. Microbiol. Infect. Dis. 11:270271.
74. Perez Blazquez, E.,, M. Montero Rodriguez,, and J. Mendez Ramos. 1994. Tuberculous choroiditis and acquired immunodeficiency syndrome. Ann. Ophthalmol. 26:5054.
75. Philip, R. N.,, G. W. Comstock,, and J. H. Shelton. 1965. Phlyctenular keratoconjunctivitis among Eskimos in Southwestern Alaska. Am. Rev. Respir. Dis. 91:171187.
76. Pilai, S.,, T. J. Malone,, and J. C. Abad. 1995. Orbital tuberculosis. Ophthalmic Plastic Reconstruct. Surg. 11:2731.
77. Rich, A.,, and H. McCordock. 1929. An enquiry concerning the role of allergy, immunity and other factors of importance in the pathogenesis of human tuberculosis. Bull. Johns Hopkins Hosp. 44:273.
78. Roberts, B. N.,, and C. M. Lane. 1997. Orbital tuberculosis. Eye 11:138139.
79. Rodriguez, A.,, M. Calonge,, M. Pedroza-Seres,, Y. A. Akova,, E. M. Messmer,, D. J. D’Amico,, and C. S. Foster. 1996. Referral patterns of uveitis in a tertiary eye care center. Arch. Ophthalmol. 114:593599.
80. Rosen, P. H.,, D. J. Spalton,, and E. M. Graham. 1990. Intraocular tuberculosis. Eye 4:486492.
81. Rosenbaum, P. S.,, J. N. Mbekeani,, and Y. Kress. 1998. Atypical mycobacterial panophthalmitis seen with iris nodules. Arch. Ophthalmol. 116:15241527.
82. Rosenhauch, E. 1910. Ueber das Verhaeltnis phlyctaenularer Augenentzuendungen zu Tuberkulose. Albert von Graefes Arch. Ophthalmol. 76:370396.
83. Sakai, J.,, S. Matsuzawa,, M. Usui,, and I. Yano. 2001. New diagnostic approach for ocular tuberculosis by ELISA using the cord factor as antigen. Br. J. Ophthalmol. 85:130133.
84. Salman, A.,, P. Parmar,, M. Rajamohan,, P. A. Thomas,, and N. Jesudasan. 2003. Subretinal fluid analysis in the diagnosis of choroidal tuberculosis. Retina 23:796799.
85. Sarvananthan, N.,, M. Wiselka,, and K. Bibby. 1998. Intraocular tuberculosis without detectable systemic infection. Arch. Ophthalmol. 116:13861388.
86. Seward, D. N. L. 1973. Tuberculoma of the ciliary body. Med. J. Aust. 1:297298.
87. Shah, S. M.,, R. S. Howard,, N. J. C. Sarkjes,, and E. M. Graham. 1988. Tuberculosis presenting as retinal vasculitis. J. R. Soc. Med. 81:232233.
88. Sheridan, P. H.,, J. B. Edman,, and S. E. Starr. 1981. Tuberculosis presenting as an orbital mass. Pediatrics 67:847875.
89. Snider, Jr., D. E.,, G. M. Cauthen,, L. S. Farer,, G. D. Kelly,, J. O. Kilburn,, R. C. Good,, and S. W. Dooley. 1991. Drug-resistant tuberculosis. Am. Rev. Respir. Dis. 144:732. (Letter.)
90. Spencer, W. H. 1996. Ophthalmic Pathology: an Atlas and Textbook, vol. 1. W. B. Saunders, Philadelphia, PA.
91. Spoor, T. C.,, and S. A. Harding. 1981. Orbital tuberculosis. Am. J. Ophthalmol. 91:644647.
92. Terson, A. 1890. Tuberculose oculaire: Excision d’un tubercule de l’iris suivi de succes. Arch. Ophthalmol. 10:714.
93. Thygeson, P. 1962. Phlyctenulosis: attempts to produce an experimental model with BCG. Investig. Ophthalmol. Vis. Sci. 1:262266.
94. van Assen, S.,, and J. A. Lutterman. 2002. Tuberculous dacryoadenitis: a rare manifestation of tuberculosis. Neth. J. Med. 60:327329.
95. Volkman, H. E.,, T. C. Pozos,, J. Zheng,, J. M. Davis,, J. F. Rawls,, and L. Ramakrishnan. 2010. Tuberculosis granuloma induction via interaction of a bacterial secreted protein with host epithelium. Science 327:466469.
96. von Jaeger, E. 1855. Über choroidealtuberkel. Desterr. Ztschr. Pract. Heilke. 1:910.
97. von Michel, J. 1881. Über iris und iritis. Albrecht von Graefe’s Arch. Klin. Exp. Ophthalmol. 27:171282.
98. Woods, A. C. 1961. Endogenous Uveitis. Williams & Wilkins, Baltimore, MD.
99. Zoric, L. D.,, D. L. Zoric,, and D. M. Zoric. 1996. Bilateral tuberculosis abscesses on the face (eyelids) of a child. Am. J. Ophthalmol. 121:717718.

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